infant toddler mental health assessment l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Infant & Toddler Mental Health Assessment PowerPoint Presentation
Download Presentation
Infant & Toddler Mental Health Assessment

Loading in 2 Seconds...

play fullscreen
1 / 161

Infant & Toddler Mental Health Assessment - PowerPoint PPT Presentation


  • 1450 Views
  • Uploaded on

Infant & Toddler Mental Health Assessment. Stacey Ryan, LCSW Angela M. Tomlin, Ph.D. Objectives. Participants will be able to Discuss the scope of mental health problems in young children Describe what IMH assessment and treatment is and is not

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

Infant & Toddler Mental Health Assessment


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
infant toddler mental health assessment

Infant & Toddler Mental HealthAssessment

Stacey Ryan, LCSW

Angela M. Tomlin, Ph.D.

objectives
Objectives

Participants will be able to

  • Discuss the scope of mental health problems in young children
  • Describe what IMH assessment and treatment is and is not
  • Explain the importance of social and emotional development to other developmental areas
objectives3
Objectives
  • Select tools and methods for assessing child development, parent-child relationships, parent capacity for relationship, and family situations
  • Demonstrate beginning knowledge of infant-toddler mental health interventions
is infant toddler mental health really a problem
Is Infant &Toddler Mental Health Really a Problem?
  • Yes!
  • Young children do experience problems in social emotional competency and even psychopathology
  • We are better able to understand and measure these problems
why we resist this
Why we resist this…
  • We are too worried about cognitive skills (“ready to learn”)
  • Stigma associated with mental health issues
  • Myth of childhood
  • Our own discomfort with the idea
prevalence
Prevalence
  • Best estimates of serious behavior concerns in children 2 to 3 years fall between 10 to 15%
  • Parent and pediatrician report behavior problems in 10% of 1 to 2 year olds
but won t these problems go away
But won’t these problems go away?
  • No!
  • 37% of 18 mos with extreme behavior/emotional problems continue to have problems at 30 mos
  • Over ½ of 2-3 with psychiatric d/o still have symptoms 2 years out
long term effects
Long Term Effects
  • Exposure to poor caregiving, abuse, or domestic violence can lead to developmental and mental health problems in young children
  • Babies, toddlers, and preschoolers can demonstrate depression, PTSD, and disruptive behaviors
the science of early childhood development
The Science of Early Childhood Development
  • Babies brains are growing at a phenomenal rate
  • The infant brain is “experience expectant”
  • Both positive and negative experiences have significant and long lasting effects
the science of early childhood development10
The Science of Early Childhood Development
  • Experience, especially social experiences, change the way the brain is shaped and functions
  • Babies who experience or witness violence have behavioral and physiological changes
the science of early childhood development11
The Science of Early Childhood Development

“Separation from parents, sometimes sudden and usually traumatic, coupled with the difficult experiences that have precipitated placement in foster care, can leave infants and toddlers impaired in their emotional, social, educational and physical development” (0-3, 2003)

so now we re thinking
So now we’re thinking…
  • OK, maybe babies and toddlers can have emotional concerns…
  • And maybe relationship is pretty important…
  • But there can’t be that many babies removed from their parents…
  • Can there?
young children in foster care
Young Children in Foster Care
  • 25% of children in foster care are under 5 years old
  • 13% of those entering care are under 1 year
  • Infants are the faster growing population in foster care
young children in foster care14
Young Children in Foster Care
  • Once in foster care, babies stay longer than other children
  • They are more likely to be abused while in foster care or when returned to parents
  • Reunification of babies placed under 3 months is low
young children in foster care15
Young Children in Foster Care

Of all the children who died from abuse and neglect,77% were under 4 years old.

mh challenges in young children
MH Challenges in Young Children
  • Are real
  • Involve a substantial number of babies
  • Can be assessed and treated
what infant toddler mental health is not
What Infant & Toddler Mental Health is NOT
  • Babies on a couch
  • Talking therapy with toddlers
  • Seeing a child without parents
  • Bonding therapies
  • Developmental therapy
what infant toddler mental health is
What Infant & Toddler Mental Health IS
  • Based on over 50 years of clinical practice
  • Informed by recent brain research findings
  • Outcome-based interventions
  • A way to understand children in their families
areas to consider when assessing young children
Areas to Consider When Assessing Young Children
  • Developmental Levels of Infant or Child
  • Quality of Important Relationships
  • Parent Status (Capacity for Relationship)
  • Family Situations
infant child development
Infant & Child Development
  • A good working knowledge of typical development is needed when you assess young children
  • You can’t tell what is atypical if you don’t know what is typical
infant child development21
Infant & Child Development
  • Expected order of milestones is knownSkills are traditionally divided into 5 areasThere is much overlap between the areasUneven development across areas is concerning
infant child development22
Infant & Child Development

Ways to learn about development

  • Have a great memory from college coursework
  • Get a child development text
  • Watch some babies
  • Review some developmental checklists online
infant child development23
Infant & Child Development
  • aap.org
  • http://thechp.syr.edu/Developmental_checklist.pdf
infant child development24
Infant & Child Development
  • Cognitive
  • Receptive, Expressive, and Pragmatic Communication
  • Fine & Gross Motor
  • Social-emotional and behavior
  • Adaptive Skills (Self Help)
cognitive skills
Cognitive Skills
  • Thinking
  • Problem Solving
  • Memory
  • Attention
  • Imitation
communication
Communication
  • Use of gestures and facial expressions
  • Understanding speech
  • Expressive language
  • Social or pragmatic aspects of communication
fine gross motor skills
Fine & Gross Motor Skills
  • Use of hands and arms to manipulate objects
  • Balance
  • Strength and tone
  • Walking, running, jumping
social emotional and behavior
Eye contact

Social smile

Relationships/attachment

Regulation

Sleep

Feeding

Aggression

Compliance

Social-emotional and behavior
self help adaptive
Self-Help/Adaptive
  • Eating
  • Dressing
  • Participation in grooming
  • Toileting
ways development can be atypical
Ways development can be atypical
  • Global delays in development
  • Inconsistent development
  • Atypical, unusual behaviors—red flags
red flags in 6 month olds
Red Flags in 6 Month Olds:
  • Inability to Read Signals
  • Persistent Sleep Problems
  • Lack of Predictability
  • Failure to Imitate Sounds and Gestures
  • No Affect, Range of Feelings
  • Lack of Stranger Anxiety (8 months)
red flags 12 18 month olds
No Words

Persistent Sleep Problems

Withdrawn

Excessive Rocking

Prolonged Fears

No Separation Distress

Immobile, Low Activity

No Social Engagement

Predominant Anger and Outbursts

Red Flags 12-18 Month Olds:
red flags in 18 months to 3 year olds
Eating Problems

Non Speaking

Extreme Shyness

Lack Autonomy

Failure in Gender Identification

No Enjoyment in Play

Poor Problem Solving

Total Lack of Self Control

Chaotic Behavior

Red Flags in 18 Months to 3 Year olds
collecting information about infant child development
Collecting Information about Infant & Child Development
  • Existing records from previous assessments
  • Screening and referral
  • Single discipline developmental assessment
  • Multi or interdisciplinary team assessment
existing records understanding test data
Existing records:Understanding test data
  • Screening or child find results
  • First Steps evaluation/Curriculum based assessment
  • Normed assessment methods/Clinic or school based
first steps
First Steps
  • Check with the SPOE for the county the child lived in before placement to see if there is a First Steps E & A
  • 1/800-441-STEP
  • http://www.in.gov/fssa/first_step/
tools used in first steps
Tools Used in First Steps
  • Goals of assessment in First Steps is to determine if eligible for program and to develop intervention plan
  • Curriculum-based tools are typically used
tools used in first steps38
Tools Used in First Steps
  • HELP and AEPS are most common
  • Have an associated curriculum
  • Are basically a list of skills to be assessed and taught
  • Sometimes yield age equivalents
first steps documentation you can use
First Steps Documentation You Can Use
  • ED Team Report
    • Will indicate developmental levels in 5 areas of development
    • Will make recommendations for services
  • Individual Family Service Plan (IFSP)
    • Will explain services that the child will receive
    • Includes information about family routines and preferences
first steps and cps
First Steps and CPS
  • Indiana now CAPTA compliant
  • In other states, the influx of referrals has been a problem for Part C
  • Some states are using screening tools, then full assessment if indicated
  • So far, we are not sure what First Steps will do with the evaluations in Indiana
clinic school assessments
Clinic & School Assessments

Independent, clinic-based assessments may have been completed

If child is 3 or near 3, a school assessment might be available

School and clinic evaluations often include norm referenced tools

clinic school assessments42
Clinic & School Assessments

Cognitive

  • BSID-3
  • DAS
  • SBIS-5
  • MSID
clinic school assessments43
Clinic & School Assessments

Communication

  • Rosetti (Caregiver Report)
  • Preschool Language Scale-4
  • Informal assessments
  • AAC
clinic school assessments44
Clinic & School Assessments

Adaptive Behavior

VABS-2

SIB-R

ABAS

clinic school assessments45
Clinic & School Assessments

Motor Assessments

Peabody Developmental Motor Scales-2

VMI

clinic school assessments46
Clinic & School Assessments

Social-Emotional and Behavioral

ITSEA

BASC

CBCL

clinic school assessments47
Clinic & School Assessments

Autism Assessments

Developmental History

ADOS

Checklists (Gilliam, CARS, MCHAT)

what to do if
What to do if…

No previous developmental assessment??

  • Conduct your own developmental assessment
  • Get full E & A thru First Steps
  • Screen and refer
screening referral
Screening & Referral
  • Screening methods tell you if the child needs further assessment in a given developmental area
  • Many screening tools use caregiver report
  • Do not use social-emotional screener for CPS population
suggested developmental screening tools
Suggested Developmental Screening Tools
  • Caregiver Report Methods
    • Ages & Stages Questionnaires
    • PEDS
    • DOCS
  • Direct Assessment of Child
    • Denver-II
    • Bayley Infant Developmental Screener
    • Batelle Developmental Inventory Screening Test
infant toddler mse
Infant-Toddler MSE
  • Must understand development
  • Good observation skills
  • Experience with infants and young children
infant toddler mse52
Appearance

Reaction to Situation

Adaptation: Exploration and Reaction to Transitions

Self Regulation

Sensory Regulation

Unusual Behaviors

Activity Level

Attention Span

Frustration Tolerance

Expression of Aggression

Muscle Tone and Strength

Gross and Fine Motor Coordination

Infant Toddler MSE
infant toddler mse53
Infant/Toddler MSE
  • Speech and Language
  • Thought Processes
  • Affect and Mood
  • Play
  • Cognition
  • Relatedness
do s and don ts
Do’s and Don’ts
  • Infants and Toddlers must be evaluated within the context of relationships with their primary caregivers
  • Assessment should always include collaboration with parents and caregivers
  • Multiple assessments over time are recommended
  • Information from Multiple sources is recommended
do s and don ts55
Do’s and Don’ts
  • Standardized Instruments May be used
  • but not be the sole basis of the Evaluation
  • Young Children Should Never be Challenged
  • by Separation from Primary Caregivers
  • Evaluation should utilize the DC 0-3 system
  • along with DSM IV
assessing quality of parent child relationship
Assessing Quality of Parent-Child Relationship
  • Attachment: research and clinical findings
  • Tools for assessing relationships
  • Suggested observation strategies
relationship problems vs mental health dx
Relationship Problems vs Mental Health DX
  • Do not assume that all of these children will have an attachment problem
  • Relationship problems and other MH problems can co-occur
  • Can have MH concern with good relationship
attachment
Attachment
  • Attachment means a specific relationship between one child and one adult
  • It only refers to a relationship that occurs when the adult is in a caregiving role for that child
  • Children can have attachment problems that do not reach the level of a disorder
  • Attachment problems predict problems with future relationships
attachment60
Attachment
  • Ainsworth/Bowlby introduced the secure/insecure attachment paradigm
  • These research categories only work loosely in a clinic setting
reactive attachment disorder
Reactive Attachment Disorder

What it is:

  • Markedly disturbed and developmentally inappropriate social relatedness in most contexts
  • Presumed due to pathogenic care (maltreatment, lack of consistency)
reactive attachment disorder62
Reactive Attachment Disorder

Two Patterns:

  • Excessive inhibition, hypervigilant, highly ambivalent behaviors
  • Indiscriminate sociability
reactive attachment disorder63
Reactive Attachment Disorder
  • Both patterns are know to occur in children who have been in foster care and those raised in institutional settings
parent child observations
Parent-Child Observations
  • Most important to have a routine process
  • Multiple observations over time are best
  • If possible, see parent and child in different settings
areas to observe when assessing parent and child interactions
Areas to Observe when Assessing Parent and Child Interactions

Attachment Behaviors

Play Interactions

Direction/Teaching

Separation/Reunion

observing attachment behaviors
Observing Attachment Behaviors
  • Does the child seem to feel safe, secure, and comfortable? Can the child explore, play with toys, interact with the examiner?
  • What does the caregiver do to help the child get comfortable?
  • Can the child and the caregiver share enjoyment?
  • How does the child respond when the caregiver restricts her?
observing play behavior
Observing Play Behavior
  • Who leads the play?
  • Is the play mutual?
  • Is the play reciprocal?
  • Does the parent provide scaffolding?
  • Is the affect positive or negative?
  • Is the play sustained?
observing teaching
Observing Teaching

Parent and child most often asked to clean up/Or a teaching task

  • How does parent explain the task?
  • Does child follow instructions?
  • How does parent handle refusals?
  • Does parent provide scaffolding?
  • Emotional tenor of interaction
separation reunion
Separation/Reunion
  • Parent can be asked to leave room briefly
  • Purpose is to elicit attachment behaviors at both points
  • Avoid if it would be too stressful
clinical attachment systems
Clinical Attachment Systems
  • DC 0-3 R offers a system of classification for young children
  • Includes Relationship Classification
  • Can help us know what to look for in assessing the relationship and interactions between a young children and parents
dc 0 3r relationship assessment
DC 0-3R Relationship Assessment
  • Overall functional level of child and parent
  • Level of distress of child and parent
  • Adaptive flexibility of child and parent
  • Level of conflict and resolution between child and parent
  • Effect of the quality of the relationship on the child’s development DC 0-3R, 2005
dc0 3r tools for assessing parent infant relationship
DC0-3R Tools for Assessing Parent-infant Relationship
  • Parent-Infant Relationship Global Assessment Scale (PIR-GAS)
  • Relationship Problems Checklist DC 0-3 R, 2005
  • zerotothree.org
pir gas
PIR-GAS
  • Used by a clinician to make a judgment about relationship classification
  • Range from well-adapted to severely impaired
  • Need to identify frequency, intensity, and duration of problems to classify the problem
pir gas74
PIR-GAS
  • So not have to know etiology of problems to use classification
  • Is a seen as a current description of relationship that can change
pir gas categories
Well Adapted

Adapted

Perturbed

Significantly Perturbed

Distressed

Disturbed

Disordered

Severely Disorder

Grossly Impaired

Documented maltreatment

PIR-GAS Categories
relationship problems checklist rpcl
Relationship Problems Checklist (RPCL)
  • Helps the clinician document the presence or absence of problems in a relationship
  • Helps support the following descriptors of relationship
  • Can be used for more than one primary relationship
rpcl areas
RPCL Areas
  • Behavioral Quality of Interaction
  • Affective Tone
  • Psychological Involvement
slide78
Overinvolved

Underinvolved

Anxious/Tense

Angry/Hostile

Verbally Abusive

Physically Abusive

Sexually Abusive

RPCL
underinvolved
Underinvolved

Behavior Quality:

  • Insensitive/unresponsive to cues
  • Does not protect child
  • Child appears uncared for
underinvolved80
Underinvolved

Affective Tone

  • Affect in both partners seems sad, constricted, withdrawn, and flat
  • To observer, interactions suggest lack of pleasure
underinvolved81
Underinvolved

Psychological Involvement:

  • Parent does not demonstrate awareness of infant cues by behavior or in discussion with others
  • Parent with history of emotional deprivation or neglect
physically abusive
Physically Abusive

Behavioral Quality:

  • Parent physically harms child
  • Parent regularly fails to meet child’s basic needs
physically abusive83
Physically Abusive

Affective Tone:

  • Reflects anger, hostility, or irritability
  • Considerable to moderate tension and anxiety are present
physically abusive84
Physically Abusive

Psychological Involvement:

  • Parent exhibits and/or describes anger or hostility toward child
  • Child may have tendency toward concrete behavior
  • Periods of closeness vs distance
additional parent child tools
Additional Parent child tools
  • Crowell Procedures
  • Parent Child Early Relational Assessment
relationship assessment crowell procedure
Relationship AssessmentCrowell Procedure
  • Free play
  • Clean up
  • Teaching Tasks
  • Separation/Reunion
domains
Parent

Emotional Availability

Nurturance

Protection

Child

Emotional Regulation

Security

Vigilance

Domains
domains88
Parent

Comforting

Teaching

Discipline

Structure/Routine

Child

Comfort-seeking

Learning

Self-control

Self-regulation

Domains
parent child early relational assessment
Parent Child Early Relational Assessment
  • For birth to 5 years
  • Parent and child are videotaped during interaction in 4 5 minute segments (feeding, structured task, free play, and separation/reunion)
  • Observations are scored on Likert scale
parent child early relational assessment90
Parent Child Early Relational Assessment
  • Parent Domains
    • Expressed Affect and Mood
    • Expressed Attitude Toward child
    • Affective and Behavioral involvement with child
    • Parenting Style
parent child early relational assessment91
Parent Child Early Relational Assessment
  • Infant/Child Domains
    • Mood/affect
    • Behavior/adaptive ability
    • Activity level
    • Regulatory capacities
    • Communication
    • Motoric competence
parent child early relational assessment92
Parent Child Early Relational Assessment
  • Parent/Child Dyad
    • Affective quality of interaction
    • Mutuality
    • Sense of security in relationship with parent
assessing parent capacity for relationship
Assessing Parent Capacity for Relationship
  • Adult Attachment Interview
  • Working Model of the Child Interview
  • Parenting Stress Index-Third Edition
working model of the child
Working Model of the Child
  • Structured interview that assesses parents’ internal representations of a their relationship to a specific child.
  • Parent responds to 19 questions
  • Responses are rated and scored
  • Overall interviewed is rated as balanced, disengaged and distorted.
adult attachment interview
Adult Attachment Interview
  • Semi-structured interview that assesses person’s way of thinking current and past relationship
  • Parent status on AAI predicts child security of attachment
adult attachment interview97
Adult Classification

Secure/autonomous

Dismissing

Preoccupied

Unresolved/disorganized

Child Classification

Secure

Avoidant

Resistant/

Ambivalent

Disorganized

Adult Attachment Interview
parenting stress index third edition
Parenting Stress Index, Third Edition
  • Parent checklist; 120 items
  • Child Domain
  • Parent Domain
  • Total Stress
  • Assess for defensive responding
  • Screener available
  • Large body of research
parenting stress index third edition99
Parenting Stress Index, Third Edition
  • Child Domain
    • Distractibility/hyperactivity
    • Adaptability
    • Reinforces Parent
    • Demandingness
    • Mood
    • Acceptability
parenting stress index third edition100
Parenting Stress Index, Third Edition
  • Parent Domain
    • Competence
    • Isolation
    • Attachment
    • Health
    • Role Restriction
    • Depression
    • Spouse
parent evaluations
Parent Evaluations…
  • Most common Psychiatric Dx
    • Depression
    • Personality Disorder
  • Developmental/MR
  • Addictions
  • Vocational
parent psychiatric evaluations
Parent Psychiatric Evaluations
  • Depression and PD can result in significant effects on children
  • Attachment problems are common
  • Behavior concerns are often significant
  • Child possibly at risk for developing psychiatric dx
cognitive limitations
Cognitive Limitations
  • Significantly below average cognitive and adaptive skills
  • Ranges from mild to profound
  • Most individuals with mental handicap who are parents are likely to be in the mild to moderate range
parenting and cognitive limitations
Parenting and Cognitive Limitations
  • IQ relates to parenting behavior when below 55-60
  • MH in parent increases chances of mental handicap in child
  • Families with parent with MH are increasing
parenting and cognitive limitation
Parenting and Cognitive Limitation
  • Need for direct assistance
  • Difficulties with transfer of knowledge
  • Hard to keep track of multiple issues
  • May lack basic academic skills
  • Lack of knowledge about children
  • Abuse potential unclear
parenting and cognitive limitations106
Parenting and Cognitive Limitations
  • With appropriate supports, most parents with MH can learn to be good parents
screening adults for mh
Screening Adults for MH

Ask about parents’ school history:

“How far did you go in school?”

“Were you able to finish school?”

“Did anyone in the family receive extra help at school?”

“Do you remember what kind of help you received in school?”

screening adults for mh108
Screening Adults for MH

Observe:

Hygiene and dress

Ability to prepare meals

Money management

Tidiness and Cleanliness of Home

Ability to relate to others

parents with addiction
Parents with Addiction

Effects on Family Interactions

  • More conflict
  • More family problems
  • Less structure and discipline
  • Increased expectations for child independence
  • More physical discipline (boys)
parents with addiction110
Parents with Addiction

Relation to child abuse

  • Child abuse professionals report that substance abuse contributes to between ½ and ¾ of child abuse
  • Alcohol addiction related to physical abuse; cocaine addiction to sexual abuse
  • Children exposed to drugs prenatally are 2-3 times more likely to be abused or neglected
parents with addiction111
Parents with Addiction
  • Children of addicted parents are more likely to be in foster care and to stay longer
  • Children of addicted parents more likely to be depressed, anxious, and have psychiatric diagnoses
  • Children of addicted parents have more problems in school
family situations
Family Situations
  • Strengths
  • Weaknesses
  • Risk Factors
  • Cultural factors
risk factors
Risk Factors
  • Poverty
  • Domestic Violence
  • Community Violence
  • Lack of Support
  • Reluctance to Accept Help
  • Inconsistent Care giving Experiences
risk factors114
Risk Factors
  • Negative Maternal Attitude Toward

Pregnancy

  • High level of perceived social stress
  • Loss of previous child, history of child maltreatment
  • Young Maternal Age and Single Marital Status
  • Marital Discord
cultural issues
Cultural Issues
  • Always view the cultural framework as a set of tendencies or possibilities
cultural shapes beliefs and practices
Cultural shapes beliefs and practices
  • What and how a family is
  • How children are to behave
  • How children are to be treated
  • Ideas related to health and disability
  • How to relate to professionals
  • Communication styles
considering culture
Considering Culture
  • Recognize and understand cultural paradigms
  • “The family” as defined by the family has a contribution to make in understanding a child
  • Demonstrating willingness to learn about different cultures helps
results of child evaluation
Results of Child Evaluation
  • DSM categories that work
  • DC 0-3 R Axis One dx
slide119
Should babies and toddlers be “Diagnosed”?
  • If no, how can we bill?
  • If yes, what diagnoses can be considered?
psychiatric diagnoses
Psychiatric Diagnoses
  • DSM IV TR Diagnoses such as depression, PTSD, adjustment disorders, and disruptive behavior disorder, NOS can be used
  • Some efforts to modify criteria are in progress
slide121
PTSD
  • Items that require verbalization of inner experience are revised
  • Fewer symptoms required
  • Items that involve memory reworded
  • Social withdraw replacements feelings of detachment
  • Temper tantrums added to arousal items
  • May have delays, regression, increased fears
depression
Depression
  • Appear less happy; sad; irritable; angry
  • Change in activity
  • Problems with appetite and sleep
  • Derive less pleasure from play and other activities; play themes often involve death, killing
  • Developmental regression in nearly 40%
disruptive behavior disorders
Disruptive Behavior Disorders
  • Persistent pattern of resistance to caregivers (defiant noncompliance)
  • Deliberate attempts to annoy caregivers
  • Negative emotionality (chronic negative mood or emotional dysregulation)
  • Aggression
  • Deliberate, pervasive, frequent, and severe rule breaking
  • Poor social competency
psychiatric diagnoses124
Psychiatric Diagnoses

As an alternative: DC: 0 to 3

  • 5 Axis System
  • Considers primary dx and relationship status
  • Multiple crosswalks to DSM-IV and ICM-9 available for billing needs
dc 0 to 3
DC 0 to 3
  • Axis I: Primary Diagnosis
  • Axis II: Relationship Disorder
  • Axis III: Medical and Developmental Disorders and Conditions
  • Axis IV: Psychosocial Stressors
  • Axis V: Functional Emotional Developmental Level
suggested report format
Suggested Report Format
  • Identifying Information
  • Referral Source
  • Presenting Issues/Concerns
  • Assessment Components and Sources of Information
suggested report format127
Suggested Report Format
  • Family History
  • Current Living Arrangements/Concerns
  • Developmental Domains
  • Present Functioning/Mental Status Exam
suggested report format128
Suggested Report Format
  • Parent Caregiver Interactional Patterns
  • Maternal Issues Affecting Child
  • Paternal Issues Affecting Child
  • Summary/Diagnostic Findings
  • Recommendations
imh interventions
IMH Interventions
  • Core Concepts
  • Contributions
  • Strategies
  • Approaches
core concepts regarding interventions
Core Concepts Regarding Interventions
  • Since all areas of development take place within the framework of interaction between the infant and caregivers the treatment relationship needs to always include parents/caregivers (including foster parents)
core concepts for intervention
Core Concepts for Intervention
  • The parent’s capacity to nurture an infant is dependent to a great degree on the support that is available as well as the ability to use the support available.
core concepts regarding interventions132
Core Concepts Regarding Interventions
  • Interventions are based on:
    • The Contribution of the Infant
    • The Contribution of the Caregiver
    • The Contribution of the “Fit”
    • The Contribution of Stress and Cultural Factors
infant factors
Infant Factors
  • Individuality of each Infant
  • Temperament Characteristics
  • Sensory Functioning
contribution of caregiver
Contribution of Caregiver
  • Desire for a Child
  • Timing of arrival of Child
  • Expectations regarding baby
  • Perception of child
  • The real infant vs. the imagined infant
contribution of the relationship
Contribution of the Relationship
  • Fit between expectations and reality
  • Flexibility in the parent and the infant
  • Degree of conflict or disappointment
contribution of stress factors
Contribution of Stress Factors
  • What is the role of stress within the family
  • Understanding cumulative effects of stress
  • Dealing with stress may be the first point of entry
cultural factors
Cultural Factors
  • Understanding context so that stereotypes or assumptions aren’t made
  • Differences in dealing with feeding, sleeping, crying and conflicts.
interventions
Interventions

Intervention Strategies include

  • Building an Alliance
  • Meeting Material Needs
  • Supportive Counseling
  • Development of Life Skills and Social Support
  • Developmental Guidance
  • Infant Parent Psychotherapy
building trust
Building Trust
  • Consistency
  • Providing Telephone Support
  • Observes, Listens, Accepts, Nurtures
  • Visits Regularly
  • Identifies and Meets Material Needs

Infant Mental Health Services: Supporting Competencies Reducing Risks

providing for material needs
Providing for Material Needs
  • Facilitates access to community agencies
  • Assists with transportation
  • Forms alliances with other professionals on behalf of family
supportive counseling
Supportive Counseling
  • Observing
  • Listening
  • Feeling
  • Responding
development of skills and support
Development of Skills and Support
  • Develops Social Supports
  • Models Problem Solving Skills
  • Models Decision Making Skills
  • Teaches Problem Solving Processes
developmental guidance
Developmental Guidance
  • Provides Information
  • Speaks for Infant
  • Encourages Observation and Interaction
  • Models Appropriate Interaction
  • Encourages Developmentally Appropriate Activities
infant parent psychotherapy
Infant Parent Psychotherapy
  • Assists the Parents to: Develop new and healthier patterns of Interaction
  • Identify feelings and put them into words
  • Understand reactions, defenses and coping strategies
  • Form Corrective Attachment Relationship
intervention methods
Intervention Methods
  • Interaction Guidance
  • Infant-Parent Psychotherapy
  • Floortime
interaction guidance
Interaction Guidance
  • Susan McDonough, Ph.D. MSW
  • For high risk families
  • Relationship-based
  • Use of videotape
  • Focus on positive interaction between parent and child
infant parent psychotherapy147
Infant-Parent Psychotherapy
  • Alicia Lieberman
  • Don’t Hit My Mommy! A Manual for Child-Parent Psychotherapy with Young Witnesses of Family Violence
floortime
Floortime
  • Stanley Greenspan, MD & Serena Weider, PhD
  • Use of play at specific developmental levels
  • Play as communication
  • Following the child’s lead
special issues for foster parents
Special Issues for Foster Parents
  • Foster parents may have been told not to get too close to children in care
  • In past, it was believed that it was confusing for children to feel too close to foster parents
attachment to foster parents
Attachment to Foster Parents
  • Now we believe that attachments to foster parents should be encouraged
  • It can be hard for children to have separations from parents
  • But the long term effects of no attachments at all are more damaging
attachment to foster parents151
Attachment to Foster Parents
  • Foster parents should be encouraged to help the child develop a healthy attachment
  • The child will be able to extend this attachment to birth family, new foster family, or adoptive family
ways to help foster parents
Ways to Help Foster Parents
  • Help foster parents understand that the child needs them even when they do not show it
  • Understand that rejecting behaviors are old coping methods
for more on foster care
For more on foster care
  • Mary Dozier, Ph.D.
reflective supervision
Reflective Supervision
  • Reflective Supervision is clinical supervision using a reflective-practice model
  • Considered essential in infant-toddler work
reflective skills
Reflective Skills
  • Listening
  • Demonstrating empathy
  • Promoting reflection
  • Observing the parent-child relationship
  • Respecting role boundaries
  • Respond thoughtfully
  • Understand, regulate, and use one’s one feelings
reflective supervision156
Reflective Supervision
  • “A safe place to process complex situations and emotions” Linda Gilkerson
components of reflective supervision
Components of Reflective Supervision
  • Reflection
  • Collaboration
  • Regular Meetings
next steps
Next steps….
  • What do you want to do for follow up?
  • Phone consultation?
  • Additional Training?
  • General vs Case-specific?
  • Your Ideas?
for later questions
For Later Questions…
  • atomlin@iupui.edu
  • yphrdir@cmhcinc.org
infant toddler mental health assessment161

Infant & Toddler Mental HealthAssessment

Stacey Ryan, LCSW

Angela M. Tomlin, Ph.D.